Journal of Clinical Chiropractic Pediatrics

http://www.jccponline.com/

Links: www.ICApediatrics.com

an International Journal

Current Issue: Vol. 14, Issue 2 (2014)

The Journal of Clinical Chiropractic Pediatrics (JCCP) is the official peer-reviewed journal of the ICA Council on Chiropractic Pediatrics. It is committed to publishing research, scientific and professional papers, literature reviews, case reports and clinical commentaries for chiropractors and other health care professionals interested in the treatment of the pregnant, postpartum and pediatric patient. Through the publication of these papers and the dissemination of this information, the JCCP seeks to encourage professional dialogue and awareness about chiropractic pediatric care to help enhance patient care and improve patient outcomes.

Editors: Sharon A. Vallone, DC., DICCP., Cheryl Hawk, DC, PhD.

Welcome to the premier issue of the Journal of Clinical Chiropractic Pediatrics in its new open access format. We are hopeful that this venue will provide field clinicians interested in maternal health and pediatric chiropractic with current research, case reports and clinical commentary that they will find both useful and informative. We invite you to submit your own research or scientific writing for consideration for publication in this journal.

Editorial

Is modern technology affecting our children’s musculoskeletal and neurological development?

By Sharon A. Vallone, DC, FICCP

Products of modern technology can be valuable tools for education. They provide a means of communication for many of our nonverbal children. The academic environment is rapidly promoting proficiency in our children around technology. But let’s not rush. The window of learning the world in the early years of life is irreplaceable. Multi-sensory experiences of normal, everyday life are actually far richer than getting to experience everything in the world through the screen of a tablet.

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Articles

Adverse reactions of medications in children: The need for vigilance, a case study

By Edward Holmes, DC and Joyce Miller, BSc, DC, DABCO, FCC

Summary: This study demonstrates that adverse drug reactions can potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

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Deformational plagiocephaly and chiropractic care: A narrative review and case report

By Jennifer L. Hash, DC

Abstract: An increase in deformational plagiocephaly has been noted since 1992, when the American Academy of Pediatrics began recommending infants be placed to sleep in the prone position, in an effort to decrease the number of Sudden Infant Death Syndrome (SIDS)-associated deaths. Intrauterine constraint, late gestational age, birthing forces/trauma, and postnatal positioning also play a role in the development of this condition. Once believed to be a purely cosmetic problem, studies and reports are now linking deformational plagiocephaly to possible mental, psychomotor, or developmental delays, auditory processing disorders, strabismus, and mandibular asymmetry. Non-intervention, positional changes, physical therapy, cranial remodeling orthotics, and surgical procedures are traditionally utilized to treat this condition. A literature search was conducted using the Cochrane Library, PubMed, Science Direct, and the Index to Chiropractic Literature. Publications were included if they were systematic reviews, RCTs with a control group, or specifically related to plagiocephaly interventions. The intent of this case report is to describe the result of chiropractic care on a single patient with deformational plagiocephaly. No adverse effects were reported as a result of the therapy and the patient’s chief complaint of right-sided occipital flattening resolved completely during the course of treatment.

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Chiropractic treatment of gastro-esophageal reflux disease in a pediatric patient: A case report

By Andrew Chuang, DC, MClinChiro

Objective: To describe the case of an infant with gastro-esophageal reflux disease which improved while under chiropractic care and to review the literature on chiropractic manipulation and gastro-esophageal reflux disease. Clinical Features: A 4-month-old female with gastro-esophageal reflux disease was brought into the clinic by her mother for chiropractic care. The mother reports of multiple episodes of reflux and vomiting per day. Slight asymmetry of the frontal bone was noticed with a flattening of the left side. Methods: A literature search of PubMed using the subject heading “gastro-esophageal reflux disease AND chiropractic” or “GERD AND chiropractic” or “acid reflux disease AND chiropractic” was performed. Intervention and Outcomes: The patient was treated with chiropractic manipulation in the form of sustained pressure and Activator adjusting instrument. Recommended treatment frequency was 2x/week for 2 weeks and 1x/week for 4 weeks after. Cranial adjustments were performed, particularly on the frontal bone. The patient’s mother reported a large bowel movement after the adjustment on the same day and a longer than normal subsequent sleep cycle. At the next visit the patient’s mother reported that the number of episodes per day of vomiting and reflux had decreased. Over the next 3 weeks both the number of episodes per day and number of days with any vomiting and reflux decreased. Within 3 weeks the infant had no reflux or vomiting. Conclusion: There is limited literature about the effect of chiropractic care as a treatment for gastro-esophageal reflux disease. There are reports of successful chiropractic treatment of gastro-esophageal reflux disease. This patient’s reflux and plagiocephaly improved while under chiropractic care.

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Demographic survey of pediatric patients presenting to chiropractic clinics in Norway. A short report

By Anna Allen-Unhammer, DC, MChiro

Introduction:The use of chiropractic services among pediatric patients has become a world-wide growth industry over the past ten years (Miller, 2010). Yet the demographic features of patients under 18 years of age in Norway are sparsely reported in the research literature. Accordingly, the aim of this study was to investigate the usage of chiropractic care by pediatric patients in Norway over a 12-month period. The main goals of this study were to determine the frequency of presentation in each age group, reasons for seeking care and to report on referral patterns to chiropractors.

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Pediatric cholelithiasis and breastfeeding difficulties: A chiropractic case report

By Michelle A. Hubbard, MChiro

Objective: Through presenting the case of a 7-week-old the object of this report is to create awareness of the increasing rate of cholelithiasis in the pediatric population, and to outline how chiropractic care assisted in the resolution of breastfeeding difficulties. Design: A case report. Clinical Features: Following a chiropractic health history and physical examination it was identified that the breastfeeding difficulties were a consequence of a combination of issues. The infant was found to have limited left rotation of the neck, a result of upper cervical subluxations and cranial misalignments, and ankyloglossia (tongue-tie). Further investigation via stool analysis, abdominal ultrasound and blood testing led to the diagnosis of fetal cholelithiasis with an underactive gallbladder. Intervention & outcomes: Chiropractic adjustments were implemented to correct the cervical and cranial motion. Mother and child were also placed on daily probiotic supplementation. After one month of weekly chiropractic care the child was found to have normal cervical range of movement. A frenotomy was performed at 10 weeks old. The infant displayed complete resolution of the breastfeeding difficulties. At 11 weeks the infant was placed on 1.2ml Ursofalk ursodeoxycholic acid (bile acid) twice a day and 0.2ml colecalciferol (VitD) daily. This continued for one month. No further treatment was implemented for the cholelithiasis. Conclusion: As primary care practitioners it is essential that chiropractors recognize and understand the pathophysiology of gallbladder disease in the pediatric population. It is possible that the presenting symptoms may be misdiagnosed and therefore lead to inappropriate treatment. In this case a multidisciplinary approach was required to manage the various presentations. Chiropractic care resolved the biomechanical component of the breastfeeding difficulties which occurred concurrently with the cholelithiasis.

Key words: chiropractic, pediatrics, breastfeeding, subluxation, fetal, cholelithiasis, gallstones, gallbladder.

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Chiropractic and breastfeeding dysfunction: A literature review

By Lauren M. Fry, BAppSc (CompMed-Chiro), MClinChiro

Objective: Breastfeeding an infant has many long and short-term health benefits. Chiropractic care, as part of a multidisciplinary team, has the potential to assist with biomechanical causes of breastfeeding dysfunction. The purpose of this study was to review the literature and explore what evidence there is to support this theory. Methods: Database searches were performed (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health and Index to Chiropractic Literature) and hand searches to identify relevant studies. Inclusion criteria were: written in the English language in a peer-reviewed journal, involving infant human participants and a focus on chiropractic treatment for breastfeeding (dysfunction). Results: Eleven articles were reviewed; 6 case studies, 3 case series, 1 clinical trial and 1 narrative. Conclusions: Limited evidence exists to support chiropractic treatment for infants with breastfeeding dysfunction. Of the 6 case studies, 3 case series and 1 clinical trial found in this report there was a trend towards resolution of breastfeeding issues with chiropractic treatment of biomechanical imbalances. More meticulous, higher evidence studies are needed to provide further evidence of this.

Key words: breastfeeding, chiropractic, infant, spinal manipulation.

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Weight limit recommendation in backpack use for school-aged children

By Valérie Lavigne, DC

Background: Every day, children use backpacks to get their books back and forth from school. Many children carry very heavy backpacks and there are some concerns that this could be contributing to back pain in children. Objective: The purpose of this paper is to assess, using the literature, what is the recommended weight limit that should be carried by school-aged children. Discussion: Many organizations, such as Back Pack Safety International, are trying to educate children on how to wear their backpacks properly and on the weight limit those children should carry to minimize back pain. However, many factors such as design, weight, how it is worn, and children’s physical fitness have been shown to have an influence on the development of pain caused by backpacks. As well, parents and teachers have a determining role in helping children be better organized to have lighter backpacks. The literature does not seem to agree on a set weight limit but it is shown that to prevent back pain it should definitely not exceed 10-15%. Conclusion: Backpacks have an influence on back pain in children and the weight limit should not exceed 10-15% of the child’s body weight.

Key words: backpack, back pain, school-aged, chiropractic

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Improvement in prematurity outcome: A chiropractic case report

By Carmel Therese Whelan, BAppSci(Chiro), DICCP

Purpose: Prematurity carries with it an increased risk of developmental delays, infections, language development disorders and delays, visual and visuocognitive development disorders and mental health issues later in life. The purpose of this case report is to add to the possible avenues of treatment to gain better outcomes for this population. Method: A thorough literature search of MANTIS, BioMed Central, PubMed and National Institute of Health (NIH) revealed that there was not one published case on the use of chiropractic in the treatment of prematurity. Case: In this case, the child was born at 26.6 weeks – after 14 weeks of antepartum hemorrhage(APH) and so was at the end of the spectrum for viability. He spent 58 days in neonatal intensive care unit (NICU) and a further 44 days in special care nursery (SCN) until he was released to go home. Intervention: The patient was treated chiropractically with low force techniques utilizing sacro-occipital cranial techniques and neurological stimulation to improve proprioceptive input to the cerebellum and to decrease the level of deformational plagiocephaly. Outcomes: Treatment was continuous throughout the first two years of life beginning weekly and then every two weeks for regular checkups. His most recent assessment through the Southern Health Growth and Development Clinic showed that he is achieving at least within the normal range for his age and frequently above average across the different scales of the Bayley Scales of Infant Development-3rd edition. Conclusion: The patient responded favorably to the regular chiropractic management of sacro-occipital technique and neurological stimulations exercises. He is now outperforming many of his non age corrected peers. It is the hypothesis of the author that the maintenance of normal joint function and movement – including the cranial sutures – globally enhanced the outcomes of this child and could be a source of improved outcomes for this demographic in the future.

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